=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114348745
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHARON WYATT MOORE MD, MBA, MPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2013
-----------------------------------------------------
Last Update Date | 12/28/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1241 VOLUNTEER PKWY SUITE 950
-----------------------------------------------------
City | BRISTOL
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37620-4659
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-968-9533
-----------------------------------------------------
Fax | 423-968-3567
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1241 VOLUNTEER PKWY SUITE 950
-----------------------------------------------------
City | BRISTOL
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37620-4659
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-968-9533
-----------------------------------------------------
Fax | 423-968-3567
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083P0901X
-----------------------------------------------------
Taxonomy Name | Public Health & General Preventive Medicine Physician
-----------------------------------------------------
License Number | MD17978
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------